Treating obesity: Comfort, affliction, and confusion

Perhaps you already know the behind-closed-doors guiding principles of the news media, but if so, I suppose I’m a bit naïve in comparison. I thought they would be all about reliably reporting the news. Instead, I learned this guiding principle during my days working as an on-air contributor for ABC News’ Good Morning America: “Comfort the afflicted, and afflict the comfortable.” This is by no means an ABC mantra; it’s industry-wide. And if we append to these two a third — “propagate perennial confusion all around” — we might just about have the complete picture.

That’s the problem. That addendum of mine follows logically and all but invariably from the prevailing devotion to the first two dicta.

Here’s why:

Let’s say you are among the afflicted. This comes in many flavors, of course. But because ratings and audience size matter, you may not get much comfort unless you happen to be afflicted in one of the more popular ways. So if you have a rare disease or some uncommon misfortune, your story may get airtime when it’s time to afflict others — but you shouldn’t expect much on-air comfort.

But, if you are struggling with your weight, for example — then you are blessed with a very popular affliction. You will be comforted, and often. Unfortunately, since there isn’t anything both new and actually valid for weight loss every week, day and hour — your comfort will largely come in the form of unsubstantiated hooey, misguided fads, and silly fashions. You will hear about every cockamamie approach to fast weight loss that ever worked for anyone in Hollywood. You will hear about every supplement and silver bullet that might work, but actually doesn’t.

You will get your comfort in the form of effortless success, magic, and fatuous guarantees. If you are afflicted by the challenges of living better and being healthy, you will be comforted with all the ways to get there from here that require no work whatsoever. So you will feel better — until you actually try any of this nonsense. Because the promises are all false. This, in turn, will propagate your affliction — and keep you tuning in for more comfort. Somebody wins in this scenario, but it sure isn’t you.

But maybe you are not among the afflicted; maybe you are among the comfortable. On any given day, most of us are comfortable in one way or another — so we all get a steady dose of bad news to make sure we have the right balance of comfort and affliction.

But let’s be more specific. Perhaps you are comfortable that you know a drug prescribed to you by your doctor is good for you. You need to be afflicted with news about horrible potential side effects, no matter how rare.

Maybe you are comfortable with your basic knowledge of healthful eating. You need to be afflicted with competing theories every day.

If, in fact, you are comfortable in your basic understanding and beliefs about anything — based on some combination of life experience and a large and consistent body of evidence — you need to be afflicted with the latest conspiracy theory. The science inveighs consistently and overwhelmingly against any link between vaccination and autism, so you need to hear from someone who knows all of that science to be confabulated. You need to hear from her or him, no matter how lacking in credentials or genuine expertise she or he may be — because you need to be afflicted. If 9,999 studies all support the same version of truth, and one goes the other way — you need to hear about that one. It will afflict you.

And the affliction does not result in confusion commensurate with the content. It results in confusion commensurate with the coverage. That one study at odds with every other hints at scandal and conspiracy and cover-ups. So that’s the one likely to go viral. That’s the one that will reverberate forever in cyberspace. Lost in all that sauce is the most likely reason for the one result discrepant from the slowly, incrementally, and arduously aggregated weight of evidence: the one result is just plain wrong.

And so the heroes of our flavor-of-the-day news cycles are not those who prove to be right or actually know what they are talking about. The heroes on any given day are the iconoclasts, conspiracy theorists, and — just plain wing nuts. Affliction is the plat du jour, and these — its master chefs.

There are consequences of this for us all — always important, often vexing, and sometimes dire. I have seen each kind up close and personally.

For example, it has always been important to me to convey consistent and reliable sense about diet and health in my own media efforts. Some years ago, I was prepping a segment on a diet study for a major news show the following day. I was on the phone with a segment producer, senior producer, and writer — running through the Q&A: Here’s what the anchor will say, how will you answer? (The fact that the anchor in question never actually asked the questions we ran through was always part of the fun.)

Everything went fine until we got to my final punchline. At that point, the senior producer chimed in and said: “You can’t say that.” I asked why. “Because you said almost the same thing last week, and it would be boring to repeat it.”

“That may be” I said, “but the fact is that vegetables and fruits actually still are good for people this week.”

My most recent brush with the comfort-affliction-confusion trifecta relates to the NuVal nutritional guidance system. I won’t dwell on NuVal per se, except to say I consider its development my greatest contribution to public health. And, objectively, it is the first and to date only nutrition guidance system to correlate directly with health outcomes, including all-cause mortality. But I digress.

A recent Huffington Post piece written by someone I don’t know sang the praises of NuVal, and of the supermarket chains bold enough to put the unvarnished truth on display. It got a lot of attention — including from mainstream media. The next thing I knew, I was being asked to do an interview about NuVal for CBS This Morning.

Logically, since the reason for this attention was a column characterizing the unique merits and value of NuVal, one would expect that related coverage would focus on bringing the same positive news to a bigger audience. But that, I suppose, would risk comforting the already comfortable. So even though the coverage was largely positive, the associated headlines hinted at scandal. Interviewees included people with no particular credentials or knowledge of the system, invited to talk about some score they didn’t like.

This is personally rather vexing, I admit. But the issue goes way beyond me and my parochial concerns. What happens when something actually is good and works as intended, but we are given hints of scandal about it? We don’t trust anything. We can’t tell the difference between what’s legitimate and what’s not, because in a comfort-affliction-confusion paradigm, everything is treated the same. We can manage to disbelieve global warming even as the melting polar ice caps flood our basements. We can manage to believe that vaccines are sinister, even as we raise children never subject to polio.

Nothing is off-limits to the mantra, save celebrity and deep pockets. Schlemiels like you and me can do good works for a lifetime and get no attention. A celebrity who renounces pedophilia — again, this week — winds up in the middle of a media love-fest. And big companies with deep pockets can spend vast fortunes on products and practices that help make people sick, and still get a photo op with the first family for spending one-thousandth as much on helping those poor sick people.

OK, now I’m whining. Sorry.

For the most part, it’s the comfort-affliction-confusion paradigm for all. And as noted, the effects can be genuinely dire.

We got comfortable, for example, with the belief that hormone replacement therapy at menopause could prevent disease and improve quality of life. So, when studies showed that one particular form of HRT in women a decade or so out from menopause resulted in a slight excess of harms over benefits, that wasn’t nearly enough of an affliction. The story, as conveyed to us in the news media, was that HRT was a killer. That we’d been wrong, utterly wrong, in our prior comfort.

This makes for more provocative coverage, certainly. But unfortunately, it’s wrong — and lethally so. Colleagues and I have a paper due out in a major journal this summer showing how exaggerations and sweeping generalizations about HRT have cost lives. Details of that story will have to wait for the paper to come out, but they really are dire. And it’s just an example — there are others like it.

We can’t just blame this on the news media. They don’t show what we won’t watch. They won’t waste time on soundbites to which no one will listen. True, they build it; but it’s because we come, and keep coming.

But we pay a high price for doing so. We no doubt pay a price in many areas — from technology, to finance, to the environment. But I know we pay a price in public health. And our currency is human lives.

News of this sort — that emphasizes what’s new over what’s true, what’s scandalous over what’s reliable — propagates confusion and undermines genuine understanding of anything. That, to me, seems a genuine affliction. It’s an affliction we could eradicate if we could manage a cold, hard look at business as usual, and decide — we’re just no longer comfortable with it.

Treating obesity: Comfort, affliction, and confusion 6 comments

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Guest

“Comfort the afflicted, and afflict the comfortable.” This is by no means an ABC mantra”

Indeed it’s not. It comes from a character created by Finley Peter Dunne (1867 — 1936).

As a journalist in the age of “muckraking journalism”, Dunne was aware of the power of institutions, including his own. Writing as the fictional “Mr. Dooley”, Dunne wrote the following passage cautioning against the power of the newspapers themselves:

Modern day ABC would have been a target of his jape along with all other mainstream media.

http://twitter.com/piyoaworld Dennis Lee

changing diet whttp://www.shop.com/search/tls+fit+kit-Market+America-+5?s=72094&k=15&t=0#ith low glycemic foods and leave out the junk food without starving does help a long way!! That includes detoxing without diarrhea!

querywoman

I have argued with myself about posting because maybe my 80 pound weight loss has nothing to do with anyone else. But maybe it does because it represents medical advances!
My mother had unexplained weight loss, for which she got accolades. But, she had lung cancer, which should have been investigated since she was a former really heavy smoker.
I am a Type II diabetic. I started insulin over 10 years, and was really insulin resistant. I took high doses of insulin and metformin. Yes, I blew up and got much fatter on insulin.

In the past, I have occasionally refused to be weighed and told docs the truth, “All weight loss programs fail 97% of the time.”
In the final months of Mama’s illnesses, I lost a little weight due to not eating right. Then I kept getting myself on less insulin. A nurse practitioner upped my thyroid med slightly.
I saw a new endocrinologist and I thought I had lost 30 or 40 pounds due to the upped thyroid. He said I was also losing weight from being on less insulin.
I kept bringing my insulin dose down, kept losing weight. He tried me on the expensive metformin-Januvia combo pills a couple of months. Very good, then he put me on Victoza.
I lost 26 pounds the first 2 months on Victoza. I never felt weak, even then. Then I got pneumonia. Post-pneumonia, the weight loss has slowed down, but it’s still happening.
Kept cutting my insulin down to nothing. Two months ago, the endo told me to try getting off insulin completely, and added Amaryl to my cocktail of meds. I’m off insulin completely, and take metformin, Victoza, and Januvia. I’m not doing it to please my doc. I feel better, and my blood sugar doesn’t fluctuate as much.
It’s been a little scary, since Mama had unexplained weight loss due to cancer. But nothing in my body indicates a wasting disease. I bounced back nicely from the pneumonia, and feel even better now, with a new daily inhaler.
Of course, I had umpteen lab tests in the hospital and the endo did comprehensive lab work three months after the hospital. Last time he dropped my thyroid med very slightly.
On Victoza, I have had appetite loss. I always craved bready, cakey, cookie things with refined flour, but now I don’t crave them. I still eat them in smaller amounts, so there’s no deprivation.
I tell him food still tastes good to me and that I eat the same things, just not as much, and don’t crave refined flour, and don’t eat much at night.
It’s clear that the new meds actually treat the insulin resistance. I have to make sure I eat enough, and try to pump up the foods that taste best to me now, like meat, yogurt, fruit, cheese, nuts, potatoes, rice.
I just don’t crave the stuff with refined wheat as much! I don’t even know how much my doctor knows about the changed appetite, but everyone considers it good that food still tastes good to me!
Any other medical attempts at appetite loss like amphetamines were disasters!
Let’s hope there is a new day with these new meds!
I still hate being weighed, but I have to submit to it now, since the weight loss has to be monitored.

http://www.facebook.com/davidmsack David M Sack

Great rant! As a gastroenterologist trying to dispense legitimate nutritional wisdom – in the veritable shadow of Yale University – I can attest to the validity of all the criticisms. But I am reminded of Mark Twain’s famous witticism: “Everybody talks about the weather, but nobody ever does anything about it.” (perhaps a paraphrase) OK, so TV news panders. But what can we as individuals do about it? I’m all ears.

Suzi Q 38

I am so tired of “another new weight loss system.”
Don’t we have enough?
Just stop eating bad foods.
Everyone knows what they are supposed to do to lose weight.
Stop eating junk.

querywoman

Ha! Absolutely! All weight loss programs, all diets fail 97% of the time!
I am not on a diet. I am on new diabetes medicines. I am astonished at the results. Victoza does not work for everyone. I am one of my doctor’s best responses to it!
I posted here just to talk about advances in medicines!
The gila monster only eats two or three times a year. The gila has a hormone that keeps it full and slows the emptying of the stomach valve.
Humans make a similar hormone, and that is what my Victoza is based on.
I am amazed at how I don’t crave lots of refined flour foods!